Prophylactic Drain Versus No Drain in Curative Gastric Cancer Surgery-A Randomized Controlled Trial

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Clinical Trials

Background:

• Enhanced recovery after surgery protocols prompt reevaluation of routine practices like prophylactic drain placement after gastrectomy.
• Previous meta-analyses questioned the evidence supporting routine drain use, highlighting the need for further investigation.
• This study directly compares short-term outcomes of prophylactic drains versus no drains in gastrectomy patients.

Approach:

• A prospective, non-inferiority, randomized controlled trial was conducted.
• Patients with histologically proven stomach adenocarcinoma undergoing curative gastrectomy with D2 lymphadenectomy were included.
• Intra-operative randomization assigned patients to either a drain or no-drain group, with postoperative hospital stay as the primary outcome.

Key Points:

• 108 patients were randomized into two groups (54 each) after curative surgery.
• No significant differences were observed in primary outcomes (postoperative hospital stay) or secondary outcomes (bowel function, feeding, re-surgery, morbidity, mortality) between the drain and no-drain groups.
• Median ages were comparable between groups (55 vs. 58.5 years).

Conclusions:

• Omitting prophylactic drains after gastrectomy with D2 lymphadenectomy for stomach adenocarcinoma is non-inferior to drain placement.
• Routine prophylactic drain placement following this procedure can be safely avoided.
• This finding supports streamlining surgical protocols and potentially reducing patient burden.